| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,015 |
6,941 |
$396K |
| D1120 |
Prophylaxis - child |
6,759 |
6,688 |
$258K |
| D0230 |
Intraoral - periapical each additional radiographic image |
39,241 |
8,166 |
$159K |
| D1110 |
Prophylaxis - adult |
1,445 |
1,439 |
$122K |
| D1351 |
Sealant - per tooth |
4,155 |
1,072 |
$108K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,334 |
8,255 |
$99K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,488 |
875 |
$99K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,410 |
1,407 |
$85K |
| D0210 |
Intraoral - complete series of radiographic images |
1,708 |
1,680 |
$79K |
| D0350 |
|
8,140 |
3,547 |
$75K |
| D0272 |
Bitewings - two radiographic images |
6,213 |
6,160 |
$73K |
| D9430 |
|
1,992 |
1,813 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
2,277 |
2,076 |
$27K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
52 |
43 |
$25K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
355 |
300 |
$13K |
| D1310 |
|
262 |
262 |
$11K |
| D2140 |
|
182 |
125 |
$10K |
| D9993 |
|
188 |
188 |
$8K |
| D2160 |
|
89 |
63 |
$7K |
| D7111 |
|
119 |
85 |
$7K |
| D4341 |
|
89 |
24 |
$6K |
| D2954 |
|
41 |
32 |
$4K |
| D2330 |
|
13 |
12 |
$1K |
| D0274 |
Bitewings - four radiographic images |
60 |
60 |
$738.00 |
| D0603 |
|
40 |
40 |
$555.00 |
| D1354 |
|
15 |
15 |
$490.00 |